Healthcare Provider Details

I. General information

NPI: 1831103720
Provider Name (Legal Business Name): NILESH N KOTECHA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/28/2006
Last Update Date: 03/20/2023
Certification Date: 03/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25510 INTERSTATE 45 STE 101
SPRING TX
77386-1375
US

IV. Provider business mailing address

14 LYRIC ARBOR CIR
SPRING TX
77381-6640
US

V. Phone/Fax

Practice location:
  • Phone: 832-916-2707
  • Fax: 832-924-3358
Mailing address:
  • Phone: 734-709-6477
  • Fax: 888-330-6220

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License NumberJ5600
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: